In compliance with the Affordable Care Act participants who wish to purchase benefits effective on the 91st day of employment at the prevailing COBRA rate should contact the Fund at 215-561-2722. Otherwise, benefits are effective after five months of employment.

The Prescription Plan: Active Members

Who Is Eligible

Members of PFT bargaining unit who receive all of the described dental benefits (Teachers, Non-Teaching Assistants, Comprehensive Early Learning Centers, Food Service Managers, Para Professionals, Secretarial/Clerical, Pre-Kindergarten Head Start, Professional Technical, Supportive Services Assistants, Per Diem Teachers).

The member’s spouse.

Dependent children who have not attained 26 years of age.

What the Benefit Is

All drugs that require a prescription and are not experimental, including “maintenance drugs” (i.e., thyroid pills), may be filled at any participating pharmacy. There is a $9.50 co-pay for “Brand” medications and a $6.75 co-pay for “Generic” medications. These charges are for up to a 30-day supply when using our card at participating pharmacies.

Mail Order Prescription – You may reduce your out-of-pocket costs by using the Mail Order Program. You pay $9.50 for Brand medication and $6.75 for a generic medication when you use the mail order program. However, you may receive a 90-day supply for a single co-pay.

Exclusions and Limitations

Medication for which member obtains reimbursement from any other source;

Investigational or experimental drugs;

Devices or appliances such as hypodermic syringes and needles (except for insulin), bandages, supports, or other such non-drug items;

Drugs, vitamins, diet supplements, etc., which can be purchased without a prescription. They will not be covered even if a prescription is written for them;

Medication prepared by, or ordered through, an allergist, or prepared at a pharmaceutical company;

Injectables, except for Insulin;

Genetically engineered drugs;

Fertility drugs.

How to Use the Benefit

As soon as you are eligible and have submitted a completed enrollment card, you will be mailed a Prescription Card. Thereafter, everyone who is an eligible member will be mailed a new card twice a year with effective dates of May 1 and November 1.

Destroy your old card every time you receive a new one. Take your card to a participating pharmacy and you can get prescriptions filled as described in this section. Here is how to determine if the pharmacist is a participant.

Look for the pharmacist’s membership decal.

Ask the pharmacist, if you are in doubt.

Contact the Health and Welfare Fund Office if there is any question.

Dependent Parent for Prescription Benefit Only

(Does not apply to Per Diem Teachers) You may claim the Prescription Benefit for one parent under the following conditions only:

You, yourself, are eligible for the benefit.

You have no other dependents (including spouse) that are eligible.

You claim the parent as a dependent on your income tax.

The parent is not eligible for a Prescription Benefit from any other source.

If you and your spouse are both eligible members of the Fund, and you have no eligible children, you may each claim one parent (for a total of two).

If you are claiming a dependent parent for the Prescription Benefit, you need a special form. You may obtain this form by contacting the Health and Welfare Fund Office (215-561-2722). You also will have to attach a notarized copy of your most recent income tax form, thus proving that the parent is in fact a dependent.

SOME SPECIAL QUESTIONS:

What is a Participating Pharmacy?

A participating pharmacy is one that has agreed, by contract, to provide prescriptions to eligible PFT members who show their prescription card. See the procedure for getting prescriptions under How to Use the Benefit above. You must show the Pharmacist your Prescription Card.

Can I Get Prescriptions from a Pharmacist who is Not a Participating Pharmacist?

Yes, but it may cost you something. Such a pharmacy may charge you any price. We will reimburse you only the average wholesale price, which may be less than the price you paid. You and the pharmacist must fill out a reimbursement form. You may get the form by contacting the Health and Welfare Fund Office.

How Can You Help Your Prescription Benefit Work Most Efficiently?

Once per year each member of the Health and Welfare Fund is mailed a report of the prescription claims for the member, spouse and dependents. Our aim is obvious: We want to make sure that the Fund is not being charged for a prescription or a quantity that you did not actually receive. This is how you can help:

Check the report carefully. Make sure that each medication was actually received, and in the quantity that is shown.

If there are any discrepancies or there is anything you do not understand, call the Health and Welfare Fund Office.

What Benefits are Available for Dependents of Deceased Employees?

Spouses of Health and Welfare Fund members who die will continue to be eligible for full benefits for the remainder of the current benefit period, and for all of the next benefit period. Benefit periods last 6 months, May 1st to October 31st, and November 1st to April 30th.

Example: If a covered member dies on September 1st, the spouse is covered for 8 months – September through the next April.

Benefit coverage is extended to eligible children of deceased employees as long as they remain dependent under the rules of the benefits involved.

Copyright 2016 The Philadelphia Federation of TeachersHealth and Welfare Fund